Surgical instrument for moving vertebrae

ABSTRACT

A surgical instrument extendable through a cannula for moving a first bone portion relative to a second bone portion includes a first portion having a longitudinal axis engageable with a first member connected with to the first bone portion. A second portion is engageable with a second member connected with the second bone portion. The second portion is movable relative to the first portion from a first position toward a second position to move the first and second bone portions away from each other. An actuator connected with the second portion moves the second portion relative to the first portion in a direction extending transverse to the longitudinal axis.

RELATED APPLICATION

This application is a divisional of U.S. patent application Ser. No.10/178,875, filed Jun. 24, 2002 which is assigned to the assignee of thepresent invention and is incorporated herein by reference.

TECHNICAL FIELD

The present invention relates to a surgical instrument which is used tomove bone portions, such as vertebrae of a spinal column, relative toeach other. More specifically, the present invention relates to asurgical instrument extendable through a cannula for compressing and/ordistracting vertebrae of a spinal column.

BACKGROUND OF THE INVENTION

It is known to retain vertebrae of a spinal column in a desired spatialrelationship with a longitudinal member extendable along the spinalcolumn. Fasteners connect the longitudinal member to the vertebrae.Clamping members, which threadably engage the fasteners, clamp thelongitudinal member to the fasteners. Once the longitudinal member isloosely connected with the vertebrae, a surgical instrument is used tomove the vertebrae into a desired spatial relationship by compressing ordistracting the vertebrae. The clamping members are tightened to clampthe longitudinal member to the fasteners to retain the vertebrae in thedesired spatial relationship.

It is also known to connect fasteners and a longitudinal member tovertebrae during a surgical procedure performed through a cannula. Thecannula is inserted into a body of a patient to create a working spaceadjacent the vertebrae. The fasteners and longitudinal member are thenconnected to the vertebrae to retain the vertebrae in a desired spatialrelationship.

SUMMARY OF THE INVENTION

The present invention is a surgical instrument extendable through acannula for moving a first bone portion relative to a second boneportion, such as first and second vertebrae of a spinal column. Theinstrument includes a first portion having a longitudinal axisengageable with a first member, such as a clamping member, connectedwith the first bone portion. A second portion is engageable with asecond member, such as a fastener or a longitudinal member connectedwith the second bone portion. An actuator connected with the secondportion moves the second portion relative to the first portion in adirection extending transverse to the longitudinal axis to move thefirst and second bone portions relative to each other.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other features of the present invention will becomeapparent to one skilled in the art to which the present inventionrelates upon consideration of the following description of the inventionwith reference to the accompanying drawings, wherein:

FIG. 1 is a perspective view of a surgical instrument constructed inaccordance with a first embodiment;

FIG. 2 is an exploded perspective view of the surgical instrument ofFIG. 1;

FIG. 3 is an enlarged perspective view of an end of the surgicalinstrument of FIG. 1 showing a jaw portion in a first position;

FIG. 4 is an enlarged side view of a portion of the surgical instrumentshowing a controller of the surgical instrument;

FIG. 5 is a schematic perspective view showing the surgical instrumentof FIG. 1 extending through a cannula to move bone portions relative toeach other;

FIG. 6 is a perspective view of a surgical instrument constructed inaccordance with a second embodiment;

FIG. 7 is an enlarged perspective view of an end of the surgicalinstrument of FIG. 6;

FIG. 8 is a schematic perspective view showing the surgical instrumentof FIG. 6 extending through a cannula to move bone portions relative toeach other;

FIG. 9 is a perspective view of an apparatus constructed in accordancewith a third embodiment;

FIG. 10 is an exploded perspective view of the surgical instrument ofFIG. 9;

FIG. 11 is a schematic perspective view showing the surgical instrumentof FIG. 9 extending through a cannula to move bone portions relative toeach other;

FIG. 12 is a perspective view of a surgical instrument constructed inaccordance with a fourth embodiment; and

FIG. 13 is a schematic perspective view showing the instrument of FIG.12 extending through a cannula to move bone portions relative to eachother.

DESCRIPTION OF THE INVENTION

The present invention is directed to a surgical instrument extendablethrough a cannula for moving bone portions, such as vertebrae of aspinal column, relative to each other. FIGS. 1-5 illustrate a surgicalinstrument 10 constructed according to a first embodiment. The surgicalinstrument 10 (FIGS. 1 and 2) includes a driving portion 12 having alongitudinal axis 14. The driving portion 12 is engageable with aclamping member or nut 16, one of which is shown in FIG. 5.

The clamping members 16 (FIG. 5) threadably engage fastener members 18connected with first and second bone portions, such as vertebrae 20 and21 of a spinal column. The clamping members 16 clamp a longitudinalmember, such as a plate 22, extending between the vertebrae 20 and 21 tothe fasteners 18. The fasteners 18 extend through openings 24 in theplate 22. The fasteners 18 also extend through washers 26 that permitpolyaxial positioning of the fasteners relative to the plate 22, asknown in the art.

The plate 22 and the washers 26 are clamped between the nuts 16 andintermediate portions 28 of the fasteners to retain the vertebrae 20 and21 in a desired spatial relationship. The longitudinal member 22 and thefasteners 18 are connected to the vertebrae 20 and 21 during a surgicalprocedure performed through a cannula 29. It is contemplated that theinstrument 10 could be used with any spine construct in which a nut isused to clamp a longitudinal member to a fastener.

The driving portion 12 (FIGS. 3 and 5) of the instrument 10 has an end30 with a recess 32 for receiving the nut (not shown) connected with thevertebra 20. The recess 32 has wrenching flats 33 for applying torque tothe nut. The driving portion 12 is rotatable about the longitudinal axis14 to rotate the nut relative to the fastener 18. Accordingly, thedriving portion 12 can be rotated to loosen the nut on the fastener 18and permit movement of the plate 22 connected with the vertebra 21relative to the fastener 18 connected with the vertebra 20. The nut canalso be rotated to tighten the nut and clamp the plate 22 to thefastener 18.

The driving portion 12 (FIGS. 1 and 2) has a longitudinally extendingshaft 34 extending between the end 30 and an opposite end 36 of thedriving portion. A handle 38 is connected to the end 36 of the drivingportion 12. The handle 38 may threadably engage the shaft 36 to connectthe handle with the driving portion 12. It is contemplated that thehandle 38 may be connected to the end 36 in any suitable manner. Thehandle 38 is grasped by a surgeon to manually rotate the driving portion12 about the longitudinal axis 14 to rotate the nut relative to thefastener 18.

The shaft 34 (FIG. 2) of the driving portion 12 extends through alongitudinal passage 44 defined by a longitudinally extending baseportion 50 and a longitudinally extending actuator 52. The drivingportion 12 is axially movable relative to the base portion 50 and theactuator 52. The driving portion 12 also rotates about the longitudinalaxis 14 relative to the base portion 50 and the actuator 52.

The base portion 50 has a generally C-shaped cross-section defining alongitudinal slot 54. The actuator 52 is located in the slot 54. A pairof longitudinally extending grooves 58 are located on either side of theslot 54. Longitudinally extending projections 60 on opposite sides ofthe actuator 52, one of which is shown in FIG. 2, extend into thegrooves 58. The grooves 58 in the base portion 50 guide movement of theactuator 52 relative to the base portion in opposite directionsextending parallel to the longitudinal axis 14.

The base portion 50 has a threaded end portion 66 (FIGS. 2 and 4). Acontrol wheel 68 threadably engages the end portion 66 on the baseportion 50. The control wheel 68 moves the actuator 52 relative to thebase portion 50 as the control wheel moves axially relative to the baseportion. The control wheel 68 (FIG. 2) has a hub 70 threadably engagingthe base portion 50. A grip 72 has a splined connection with the hub 70so that the hub and grip rotate together relative to the base portion50. It is contemplated that the hub 70 and grip 72 may be connectedtogether in any suitable manner or be formed as one piece.

Radially extending projections 74 and 76 on the actuator 52 (FIGS. 2 and4) extend through the slot 54 in the base portion 50 adjacent thethreaded end portion 66. The projections 74 and 76 engage opposite sidesof the control wheel 68. The projections 74 and 76 are formed as onepiece with the actuator 52, however, it is contemplated that theprojections could be welded to the actuator.

The control wheel 68 rotates about the longitudinal axis 14 relative tothe base portion 50 and the actuator 52. Upon rotation of the controlwheel 68 relative to the base portion 50, the control wheel movesaxially relative to the base portion. Rotation of the control wheel 68in one direction moves the control wheel and the actuator 52 away fromthe handle 38. The control wheel 68 applies force to the projection 74to move the actuator 52 away from the handle 38. Rotation of the controlwheel 68 in the opposite direction moves the control wheel toward thehandle 38. The control wheel 68 applies force to the projection 76 tomove the actuator 52 toward the handle 38.

A limit member 80 threadably engages the end portion 66 of the baseportion 50 with the projection 74 between the limit member and thecontrol wheel 68. The projection 74 on the actuator 52 engages the limitmember 80 to limit movement of the actuator 52 away from the handle 38relative to the base portion 50. A limit member 82 threadably engagesthe end portion 66 of the base portion 50 with the projection 76 locatedbetween the limit member 82 and the control wheel 68. The projection 76on the actuator 52 engages the limit member 82 to limit movement of theactuator toward the handle 38 relative to the base portion 50.

A hand grip 84 (FIGS. 1 and 2) is connected to the base portion 50 andengages the limit member 80. It is contemplated that the grip may bethreaded onto the end portion 66. The grip 84 may be connected to thebase portion 50 in any suitable manner. A surgeon can grasp the grip 84while manipulating the driving portion 12 or moving the control wheel68.

A jaw portion 90 (FIGS. 1-3) is pivotally connected to the actuator 52by a pivot pin 92. The jaw portion 90 has a recess 94 that receives anend 96 of the actuator 52. The pivot pin 92 extends through openings 98in the jaw portion 90, one of which is shown in FIG. 2, and through anopening 100 in the end 96 of the actuator 52.

The jaw portion 90 is pivotable relative to the actuator 52 between afirst position adjacent the driving portion 12, as shown in FIG. 3, anda second position spaced from the driving portion, as shown in FIG. 1.The jaw portion 90 extends at an angle of approximately 45° to the axis14 when in the second position. The jaw portion 90 is movable relativeto the driving portion 12 in a direction extending transverse to thelongitudinal axis 14. Upon movement of the actuator 52 toward the handle38, the jaw portion 90 pivots away from the driving portion 12. The jawportion 90 moves toward the driving portion 12 when the actuator 52moves away from the handle 38.

The jaw portion 90 has lobes 102 (FIGS. 2 and 3) that extend on oppositesides of the axis 14 into cavities 104 in the base portion 50. Uponmovement of the actuator 52 toward the handle 38 relative to the baseportion 50, the lobes 102 engage surfaces 106 on the base portiondefining the cavities 104 to pivot the jaw portion 90 away from thedriving portion 12. Upon movement of the actuator 52 away from thehandle 38 relative to the base portion 50, the lobes 102 engage surfaces108 defining the cavities 104 to pivot the jaw portion 90 toward thedriving portion 12.

The jaw portion 90 (FIGS. 1-3) has a surface 110 facing away from theaxis 14. The jaw portion 90 has a recess 114. The surface 110 isengageable with the plate 22, the nut 16, or the fastener 18 connectedwith the vertebra 21 (FIG. 5). Alternatively, the recess 114 can receivethe nut 16 or fastener 18 connected with the vertebra 21 when moving thevertebrae 20 and 21 away from each other. The jaw portion 90 (FIGS. 1-3)includes an extension 118 that extends toward the longitudinal axis 14.The extension 118 engages the plate 22, the nut 16, or the fastener 18connected with the vertebra 21 to move the vertebrae 20 and 21 towardeach other.

When the surgical instrument 10 is used to move vertebrae 20 and 21 awayfrom each other or distract the vertebrae, the instrument is insertedthrough the cannula 29, as seen in FIG. 5. The cannula 29 has a radiallyexpandable portion 124 defining a working space adjacent the vertebrae20 and 21 in a body of a patient, as known in art. The instrument 10extends through the cannula 29 with the driving portion 12 in engagementwith the nut (not shown) connected with the vertebra 20. The jaw portion90 extends into one of the openings 24 in the plate 22. Alternatively,the recess 114 in the jaw portion 90 could receive the nut 16 or thefastener 18 connected with the vertebra 21. The driving portion 12 isrotated about the longitudinal axis 14 to loosen the nut on the fastener18 connected to the vertebra 20. The plate 22, the nut 16, and thefastener 18 connected with the vertebra 21 can move relative to the nut(not shown) and the fastener 18 connected to the vertebra 20 and thevertebrae can move relative to each other.

The control wheel 68 is rotated about the longitudinal axis 14 to movethe control wheel axially toward the handle 38. The control wheel 68engages the projection 76 to move the actuator 52 in the directionextending parallel to the longitudinal axis 14 toward the handle 38. Thelobes 102 on the jaw portion 90 engage the surfaces 106 on the baseportion 50 to pivot the jaw portion about the pivot pin 92 away from thedriving portion 12. The jaw portion 90 moves in a direction transverseto the longitudinal axis 14 and engages the plate 22, the nut 16, or thefastener 18 connected with the vertebra 21. As the jaw portion 90continues to move away from the driving portion 12, the vertebrae 20 and21 are moved away from each other. When the vertebrae 20 and 21 havebeen moved to a desired spatial relationship, the driving portion 12 isrotated about the longitudinal axis 14 to clamp the plate 22 between thenut (not shown) and the fastener 18 and retain the vertebrae in thedesired spatial relationship.

When the surgical instrument 10 is used to move vertebrae 20 and 21toward each other or compress the vertebrae, the instrument is insertedthrough the cannula 29. The instrument 10 extends through the cannula 29with the driving portion 12 in engagement with the nut (not shown)connected with the vertebra 20. The jaw portion 90 is spaced from thedriving portion 12 and extends into the opening 24 in the plate 22through which the fastener 18 connected with the vertebra 21 extends.Alternatively, the extension 118 of the jaw portion 90 could engage anend of the plate 22, the nut 16, or the fastener 18 connected with thevertebra 21. The driving portion 12 is rotated about the longitudinalaxis 14 to loosen the nut on the fastener 18 connected to the vertebra20. The plate 22, the nut 16, and the fastener 18 connected with thevertebra 21 can move relative to the nut (not shown) and the fastener 18connected to the vertebra 20 and the vertebrae can move relative to eachother.

The control wheel 68 is rotated about the longitudinal axis 14 to movethe control wheel axially away from the handle 38. The control wheel 68engages the projection 74 to move the actuator 52 in the directionextending parallel to the longitudinal axis 14 away from the handle 38.The lobes 102 on the jaw portion 90 engage the surfaces 108 on the baseportion 50 to pivot the jaw portion about the pivot pin 92 toward thedriving portion 12. The jaw portion 90 moves in a direction transverseto the longitudinal axis 14 and engages the plate 22, the nut 16, or thefastener 18 connected with the vertebra 21. As the jaw portion 90continues to move toward the driving portion 12, the vertebrae 20 and 21move toward each other. When the vertebrae 20 and 21 have been moved toa desired spatial relationship, the driving portion 12 is rotated aboutthe longitudinal axis 14 to clamp the plate 22 between the nut (notshown) and the fastener 18 and retain the vertebrae 20 and 21 in thedesired spatial relationship.

A surgical instrument 210 constructed according to a second embodimentis illustrated in FIGS. 6-8. In the embodiment illustrated in FIGS. 1-5,the driving portion 12 and the jaw portion 90 are for use with aclamping nut 16 and plate 22 connected with bone portions. In the secondembodiment, illustrated in FIGS. 6-8, the driving portion and the jawportion are for use with top-loading screws and a rod connected withbone portions. Since the second embodiment illustrated in FIGS. 6-8 isgenerally similar to the embodiment illustrated in FIGS. 1-5, similarnumerals will be utilized to designate similar components and only thejaw portion and the driving portion will be described in detail.

The instrument 210 (FIGS. 6 and 7) includes a driving portion 212. Thedriving portion 212 has an end 230 with wrenching flats 232 (FIG. 7).The end 230 extends into a recess 234 (FIG. 8) in a clamping member orscrew 236 connected with a vertebra 20 to apply torque to the clampingscrew.

The clamping screws 236 (FIG. 8) threadably engage fastener housings 238to clamp a longitudinal member, such as a rod 240, extending betweenvertebrae 20 and 21 to the housings. The clamping screws 236 also clampfasteners 242 connected to the vertebrae 20 and 21 to the housings 238.The fasteners 242 are positionable in any one of a plurality of angularpositions relative to the housings 238, as known in the art. Thelongitudinal member 240, the housings 238, and the fasteners 242 areconnected to the vertebrae 20 and 21 during a surgical procedureperformed through the cannula 29. It is contemplated that the instrument210 could be used with any spine construct in which a clamping screw isused to clamp a rod to a fastener.

A jaw portion 290 is pivotally connected to an actuator 52 by a pivotpin 92. The jaw portion 290 is pivotable relative to the actuatorbetween a first position adjacent the driving portion 212 and a secondposition spaced from the driving portion, as shown in FIG. 7. The jawportion 290 extends at an angle of approximately 45° to the axis 14 whenin the second position. Upon movement of the actuator 52 toward a handle38, relative to a base portion 50, the jaw portion 290 pivots away fromthe driving portion 212. The jaw portion 290 moves toward the drivingportion 212 when the actuator 52 moves away from the handle 38.

The jaw portion 290 (FIGS. 6 and 7) includes a recess 292 defined by apair of legs 294. The jaw portion 290 receives the rod 240 between thelegs 294, as shown in FIG. 8. The legs 294 (FIGS. 6 and 7) have roundedportions 296 extending away from the driving portion 212 for engagingthe housing 238 connected with the vertebra 21 when the surgicalinstrument 210 is used to move the vertebrae 20 and 21 away from eachother. The rounded portions 296 maintain a single point of contact withthe housing 238 to permit movement of the vertebrae 20 and 21 away fromeach other. The legs 294 have extensions 298 that extend toward thedriving portion 212. The extensions 298 engage the housing 238 connectedwith the vertebra 21 when the surgical instrument 210 is used to movethe vertebrae 20 and 21 toward each other.

When the surgical instrument 210 is used to move vertebrae 20 and 21away from each other or distract the vertebrae, the instrument 210 isinserted through the cannula 29 (FIG. 8). The instrument 210 is insertedso that the driving portion 212 extends into the recess 234 in theclamping screw 236 connected with the vertebra 20. The rod 240 isreceived in the recess 292 between the legs 294 of the jaw portion 290.The driving portion 212 is rotated about the longitudinal axis 14 toloosen the screw 236. The rod 240, the housing 238, and the fastener 242connected with the vertebra 21 can move relative to the clamping screw236 and the fastener 242 connected with the vertebra 20 and thevertebrae can move relative to each other.

The control wheel 68 is rotated about the longitudinal axis 14 to movethe actuator 52 in a direction extending parallel to the axis 14 towardthe handle 38 relative to the base portion 50. The lobes 102 on the jawportion 290 engage the surfaces 106 on the base portion 50 to pivot thejaw portion relative to the actuator 52 in a direction transverse to theaxis 14 away from the driving portion 212. The rounded portions 296 ofthe jaw portion 290 move into engagement with the housing 238 connectedwith the vertebra 21 to move the vertebrae 20 and 21 away from eachother. When the vertebrae 20 and 21 have been moved to a desired spatialrelationship, the driving portion 212 is rotated to clamp the rod 240 tothe housing 238 and the fastener 242 connected with the vertebra 20 toretain the vertebrae in the desired spatial relationship.

When the instrument 210 is used to move the vertebrae 20 and 21 towardeach other or compress the vertebrae, the instrument is inserted throughthe cannula 29. The jaw portion 290 is spaced from the driving portion212 with the extensions 298 engaging the housing 238 connected withvertebra 21. The driving portion 212 is inserted into the recess 234 inthe clamping screw 236 connected with the vertebra 20. The drivingportion 212 is rotated about the longitudinal axis 14 to loosen thescrew 236. The rod 240, the housing 238, and the fastener 242 connectedwith the vertebra 21 can move relative to the clamping screw 236 and thefastener 242 connected with the vertebra 20 and the vertebrae can moverelative to each other.

The control wheel 68 is rotated about the longitudinal axis 14 to movethe actuator 52 in a direction extending parallel to the longitudinalaxis away from the handle 38 relative to the base portion 50. The lobes102 on the jaw portion 290 engage the surfaces 108 on the base portion50 to pivot the jaw portion toward the driving portion 212 transverse tothe axis 14. The extensions 298 on the jaw portion 290 engage thehousing 238 connected with the vertebra 21 and move the vertebrae 20 and21 toward each other. Once the vertebrae 20 and 21 have been moved intoa desired spatial relationship, the driving portion 212 is rotated aboutthe longitudinal axis 14 to tighten the screw 236 and clamp the rod 240to the housing 238 and the fastener 242 to retain the vertebrae in thedesired spatial relationship.

A surgical instrument 310 constructed according to a third embodiment isillustrated in FIGS. 9-11. The surgical instrument 310 has a drivingportion 312 with a longitudinal axis 314. The driving portion 312 isengageable with a clamping member or nut (not shown) threaded onto afastener 18 connected to a vertebra 20. The driving portion 312 (FIGS. 9and 10) has an end 330 with a recess 332 for receiving the nut. Therecess 332 has wrenching flats 333 (FIG. 10) for applying torque to thenut.

A longitudinally extending shaft 334 of the driving portion 312 extendsbetween the end 330 and an opposite end 336. The end 336 of the shaft334 is threadably connected to a connector member 338. It iscontemplated that the connector member 338 could be connected to thedriving portion 312 in any suitable manner. The connector member 338 haswrenching flats 340 for receiving torque from a ratcheting handle 342.The ratcheting handle 342 has an opening 344 for receiving the connectormember 338 to apply torque to the connector member. The ratchetinghandle 342 may have any suitable construction.

The shaft 334 extends through a passage 350 defined by a base portion358 and an actuator 360. The base portion 358 has a pair of axiallyspaced straps 362 for retaining the driving portion 312 in the passage350. The actuator 360 is movable relative to the base portion 358 indirections extending parallel to the axis 314.

A control lever 380 has a recess 382 defined by a pair of legs 384. Therecess 382 receives an end 386 of the base portion 358. The controllever is pivotally connected to the base portion 358 by a pivot pin 388.The pivot pin 388 extends through openings 390 in the base portion 358and through openings 392 in the legs 384 of the control lever 380.

The recess 382 in the control lever 380 also receives an end 394 of theactuator 360. The control lever 380 is pivotally connected to theactuator 360 by a pivot pin 396. The pivot pin 396 extends through anoval-shaped opening 398 in the actuator 360. Accordingly, the pivot pin396 can move in the opening 398. The pivot pin 396 also extends throughopenings 400 in the legs 384 of the control lever 380.

A jaw portion 410 (FIGS. 9 and 10) is pivotally connected to the baseportion 358. The jaw portion 410 (FIG. 10) has a recess 412 defined by apair of legs 414. The recess 412 receives an end 416 of the base portion358. A pivot pin 418 extends through openings 420 in the end 416 of thebase portion 358 and through openings 422 in the legs 414 of the jawportion 410.

The recess 412 in the jaw portion 410 also receives an end 426 of theactuator 360. The jaw portion 410 is pivotally connected to the actuator360 by a pivot pin 428. The pivot pin 428 extends through oval-shapedopenings 430, one of which is shown in FIG. 10, in the legs 414 of thejaw portion 410. Accordingly, the pivot pin 428 can move in the openings430. The pivot pin 428 also extends through an opening 432 in the end426 of the actuator 360.

Upon pivoting the control lever 380 relative to the base portion 358toward the handle 342, the actuator 360 moves in a direction extendingparallel to the longitudinal axis 314 toward the handle 342. The jawportion 410 pivots relative to the base portion 358 and the actuator360. The jaw portion 410 moves transverse to the axis 314 away from thedriving portion 312. Upon pivoting the control lever 380 relative to thebase portion 358 away from the handle 342, the actuator 360 moves in adirection extending parallel to the longitudinal axis 314 away from thehandle 342. The jaw portion 410 pivots relative to the base portion 358and the actuator 360. The jaw portion 410 moves transverse to the axis314 toward the driving portion 312.

When the instrument 310 is used to move vertebrae 20 and 21 (FIG. 11)away from each other or distract the vertebrae, the instrument isinserted through the cannula 29. The instrument 310 is inserted so thatthe driving portion 312 engages the nut (not shown) connected with thevertebra 20. The jaw portion 410 extends into the opening 24 in theplate 22 connected with the vertebra 21. Alternatively, the jaw portion410 could engage the nut 16 or fastener 18 connected with the vertebra21. The driving portion 312 is rotated about the longitudinal axis 314to loosen the nut 16 to permit movement of the vertebrae 20 and 21relative to each other.

The control lever 380 is pivoted relative to the base portion 358 andthe actuator 360 toward the handle 342. The actuator 360 moves in thedirection extending parallel to the longitudinal axis 314 toward thehandle 342. The jaw portion 410 pivots relative to the base portion 358and the actuator 360 and away from the driving portion 312. The jawportion 410 engages the plate 22, the nut 16, or the fastener 18connected with the vertebra 21 to move the vertebrae 20 and 21 away fromeach other into a desired spatial relationship. The driving portion 312is rotated about the axis 314 to tighten the nut (not shown) on thefastener 18 and clamp the plate 22 to the fastener to retain thevertebrae 20 and 21 in the desired spatial relationship.

When the instrument 310 is used to move the vertebrae 20 and 21 towardeach other or compress the vertebrae, the instrument is inserted throughthe cannula 29 with the driving portion 312 engaging the nut (not shown)connected with the vertebra 20. The jaw portion 410 is spaced from thedriving portion 312 and extends into the opening 24 in the plate 22through which the fastener 18 connected with the vertebra 21 extends.Alternatively, the jaw portion 410 could engage the end of the plate 22,the nut 16, or fastener 18 connected to the vertebra 21. The drivingportion 312 is rotated about the longitudinal axis 314 to loosen the nut(not shown) on the fastener 18 connected with the vertebra 20 to permitmovement of the vertebrae 20 and 21 relative to each other.

The control lever 380 is pivoted relative to the base portion 358 andthe actuator 360 away from the handle 342. The actuator 360 moves in adirection extending parallel to the longitudinal axis 314 away from thehandle 342. The jaw portion 410 pivots relative to the base portion 358transverse to the axis 314 and toward the driving portion 312. The jawportion 410 engages the plate 22, the nut 16, or the fastener 18connected with the vertebra 21 to move the vertebrae 20 and 21 towardeach other into a desired spatial relationship. The driving portion 312is rotated about the longitudinal axis 314 to tighten the nut (notshown) on the fastener 18 and clamp the plate 22 to the fastener toretain the vertebrae 20 and 21 in the desired spatial relationship.

The instrument 310 is shown with a driving portion 312 and a jaw portion410 for use with a nut 16 and a plate 22. It is contemplated that theinstrument 310 could have a driving portion and a jaw portion similar tothe driving portion 212 and the jaw portion 290 described in connectionwith the second embodiment, illustrated in FIGS. 6-8. The instrument 310could then be used to move vertebrae relative to each other that areconnected to a spine construct having a clamping screw and rod.

A surgical instrument 510 constructed according to a fourth embodimentis illustrated in FIGS. 12 and 13. The surgical instrument 510 includesa driving portion 512 having a longitudinal axis 514. The drivingportion 512 is engageable with a clamping member or nut 16, one of whichis shown in FIG. 13.

The driving portion 512 (FIG. 12) has an end 530 with a recess 532 forreceiving the nut (not shown) connected with the vertebra 20. The recess532 has wrenching flats 533 for applying torque to the nut. The drivingportion 512 is rotatable about the longitudinal axis 514 to rotate thenut relative to the fastener 18. Accordingly, the driving portion 512can be rotated to loosen the nut on the fastener 18 and permit movementof the plate 22 connected with the vertebra 21 relative to the fastener18 connected with the vertebra 20. The driving portion 512 can also berotated to tighten the nut and clamp the plate 22 to the fastener 18.

The driving portion 512 has a longitudinally extending shaft 534extending between the end 530 and an opposite end 536. A handle 538 isconnected to the end 536 of the driving portion 512. The handle 538 maythreadably engage the shaft 536 to connect the handle with the drivingportion 512. However, the handle 538 may be connected to the end 536 inany suitable manner. The handle 538 may be grasped by a surgeon tomanually rotate the driving portion 512 about the longitudinal axis 514to rotate the nut relative to the fastener 18.

The shaft 534 of the driving portion 512 extends through a longitudinalpassage 544 defined by a longitudinally extending base portion 550 and alongitudinally extending actuator 552. The driving portion 512 isaxially movable relative to the base portion 550 and the actuator 552.The driving portion 512 also rotates about the longitudinal axis 514relative to the base portion 550 and the actuator 552.

The base portion 550 has a C-shaped cross-section defining alongitudinal slot in which the actuator 552 is located. A pair oflongitudinally extending grooves (not shown) are located on either sideof the slot, similar to the embodiment illustrated in FIGS. 1 and 2.Longitudinally extending projections (not shown) on the actuator 552extend into the grooves. The grooves in the base portion 550 guidemovement of the actuator 552 relative to the base portion in a directionextending parallel to the longitudinal axis 514.

A control lever 560 has a recess 562 defined by a pair of legs 564. Therecess 562 receives an end 566 of the base portion 550. The legs 564have rounded ends or lobes 568, one of which is shown in FIG. 12, thatextend into cavities 570 in the end 566 of the base portion 550 onopposite sides of the axis 514.

The recess 562 in the control lever 560 also receives an end 580 of theactuator 552. The control lever 560 is pivotally connected to theactuator 552 by a pivot pin 582. The pivot pin 582 extends through anopening in the actuator 552 and through openings in the legs 564 of thecontrol lever 560.

A jaw portion 590 is pivotally connected to the actuator 552 by a pivotpin 592. The jaw portion 590 has a recess (not shown) that receives anend of the actuator 552. The pivot pin 592 extends through openings inthe jaw portion 590 and through an opening in the end of the actuator552.

The jaw portion 590 is pivotable between a first position adjacent thedriving portion 512 and a second position spaced from the drivingportion and extending at an angle of approximately 45° to the axis 514.The jaw portion 590 is movable relative to the driving portion 512transverse to the longitudinal axis 514. Upon movement of the actuator552 toward the handle 538, the jaw portion 590 pivots away from thedriving portion 512. The jaw portion 590 moves toward the drivingportion 512 when the actuator 552 moves away from the handle 538.

The jaw portion 590 has lobes 602, one of which is shown in FIGS. 12 and13, that extend into cavities 604 in the base portion 550 on oppositesides of the axis 514. Upon movement of the actuator 552 toward thehandle 538 relative to the base portion 550, the lobes 602 engagesurfaces 606 on the base portion defining the cavities 604 to pivot thejaw portion 590 away from the driving portion 512. Upon movement of theactuator 552 away from the handle 538 relative to the base portion 550,the lobes 602 engage surfaces 608 defining the cavities 604 to pivot thejaw portion 590 toward the driving portion 512.

The jaw portion 590 has a surface 610 facing away from the axis 514. Thesurface 610 has a recess 614. The surface 610 is engageable with theplate 22, the nut 16, or the fastener 18 connected with the vertebra 21.Alternatively, the recess 614 can receive the nut 16 or fastener 18connected with the vertebra 21 when moving the vertebrae 20 and 21 awayfrom each other. The jaw portion 590 includes an extension 618 thatextends toward the axis 514. The extension 618 engages the plate 22, thenut 16, or the fastener 18 connected with the vertebra 21 to move thevertebrae 20 and 21 toward each other.

Upon pivoting of the control lever 560 relative to the base portion 550and the actuator 552 toward the handle 538, the actuator 552 moves in adirection extending parallel to the longitudinal axis 514 toward thehandle 538. The jaw portion 590 pivots relative to the actuator 552 andaway from the driving portion 512. Upon pivoting the control lever 560relative to the base portion 550 and the actuator 552 away from thehandle 538, the actuator 552 moves in a direction extending parallel tothe longitudinal axis 514 away from the handle 538. The jaw portion 590pivots relative to the actuator 552 and toward the driving portion 512.

When the instrument 510 is used to move vertebrae 20 and 21 (FIG. 13)away from each other or distract the vertebrae, the instrument isinserted through the cannula 29. The instrument 510 is inserted so thatthe driving portion 512 engages the nut (not shown) connected with thevertebra 20. The jaw portion 590 extends into the opening 24 in theplate 22 through which the fastener 18 connected with the vertebra 20extends. Alternatively, the jaw portion 590 could engage the nut 16 orfastener 18 connected with the vertebra 21. The driving portion 512 isrotated about the longitudinal axis 514 to loosen the nut to permitmovement of the vertebrae 20 and 21 relative to each other.

The control lever 560 is pivoted relative to the actuator 552 toward thehandle 538. The actuator 552 moves in the direction parallel to thelongitudinal axis 514 toward the handle 538. The jaw portion 590 pivotsrelative to the base portion 550 and the actuator 552 transverse to theaxis 514 and away from the driving portion 512. The jaw portion 590engages the plate 22, the nut 16, or the fastener 18 connected with thevertebra 21 to move the vertebrae 20 and 21 away from each other into adesired spatial relationship. The driving portion 512 is rotated aboutthe axis 514 to tighten the nut (not shown) on the fastener 18 and clampthe plate 22 to the fastener to retain the vertebrae 20 and 21 in thedesired spatial relationship.

When the instrument 510 is used to move the vertebrae 20 and 21 towardeach other or compress the vertebrae, the instrument is inserted throughthe cannula 29 with the driving portion 512 engaging the nut (not shown)connected with the vertebra 20. The jaw portion 590 is spaced from thedriving portion 512 and extends into the opening 24 in the plate 22through which the fastener 18 connected with the vertebra 21 extends.Alternatively, the jaw portion 590 could engage the end of the plate 22,the nut 16, or the fastener 18 connected with the vertebra 21. Thedriving portion 512 is rotated about the longitudinal axis 514 to loosenthe nut 16 relative to the fastener 18 to permit movement of thevertebrae 20 and 21 relative to each other.

The control lever 560 is pivoted relative to the actuator 552 away fromthe handle 538. The actuator 552 moves in a direction extending parallelto the longitudinal axis 514 away from the handle 538. The jaw portion590 pivots relative to the actuator 552 transverse to the axis 514 andtoward the driving portion 512. The jaw portion 590 engages the plate22, the nut 16, or the fastener 18 connected with the vertebra 21 tomove the vertebrae 20 and 21 toward each other into a desired spatialrelationship. The driving portion 512 is rotated about the longitudinalaxis 514 to tighten the nut (not shown) on the fastener 18 connectedwith the vertebra 20 and clamp the plate 22 to the fastener to retainthe vertebrae 20 and 21 in the desired spatial relationship.

The instrument 510 is shown with a driving portion 512 and a jaw portion590 for use with a nut 16 and a plate 22. It is contemplated that theinstrument 510 could have a driving portion and a jaw portion similar tothe driving portion 212 and the jaw portion 290 described in connectionwith the second embodiment, illustrated in FIGS. 6-8. The instrument 510could then be used to move vertebrae relative to each other that areconnected to a spine construct having a clamping screw and rod.

Although the instruments 10, 210, 310, and 510 are shown moving adjacentvertebrae 20 and 21 relative to each other, it is contemplated that theinstruments could be used to move vertebrae that are not adjacent toeach other. Furthermore, it is contemplated that the instruments 10,210, 310, and 510 could be used with any cannula.

From the above description of the invention, those skilled in the artwill perceive improvements, changes and modifications. Suchimprovements, changes and modifications within the skill of the art areintended to be covered by the appended claims.

1.-34. (canceled)
 35. A method of moving a first bone segment relativeto a second bone segment in a body comprising: extending a surgicalinstrument having a first portion and a second portion through an accessdevice comprising an elongate body having a longitudinal axis and havinga proximal end and a distal end defining a working space accessibletherethrough, the working space providing access to the first and secondbone segments; engaging the first portion of the surgical instrumentwith a first member connected with the first bone segment, the firstportion having a distal tip configured to mate with the proximal head ofthe first member; coupling the second portion of the surgical instrumentwith the second bone segment; and moving the second portion of thesurgical instrument without moving the first portion of the surgicalinstrument in a direction extending transverse to the first member tomove the first and second bone segments relative to each other.
 36. Themethod of claim 35, further comprising pivoting the second portionrelative to an actuator that moves the second portion relative to thefirst portion.
 37. The method of claim 35, further comprising moving anactuator in a direction extending parallel to the first portion to movethe second portion relative to the first portion.
 38. The method ofclaim 35, further comprising configuring the surgical instrument with athird portion that at least partially defines a passage through whichthe first portion extends and an actuator that moves the second portionrelative to the first portion.
 39. The method of claim 35, furthercomprising rotating the first portion about the longitudinal axis of thefirst portion.
 40. The method of claim 35, further comprising rotating acontroller about a longitudinal axis extending through the first portionto move an actuator that moves the second portion relative to the firstportion relative to the first portion to move the second portionrelative to the first portion.
 41. The method of claim 35, furthercomprising moving the second portion away from the first portion to movethe first and second bone segments away from each other.
 42. The methodof claim 35, further comprising moving the second portion toward thefirst portion to move the first and second bone segments toward eachother.